Information technology is key to the operations of a surgery center. From front desk check-in and scheduling to medical imaging and materials management, and everything in between, IT does not represent a nice-to-have feature; it is a vital component of both business and clinical operations. At the same time, there is no shortage of new bells and whistles, and there are many vendors who tout the latest and greatest in technology, and so you could end up literally breaking the bank by chasing the next new Big Thing in healthcare IT.
How does an ASC handle IT the right way without breaking the bank? Below we give three guiding principles to save costs and increase up-time and long-term survivability:
Rule #1: Do IT right the first time. Whether you are building a new center, upgrading an existing center, or making a major change like upgrading your software, you need to look at IT as a system, taking into consideration the entire needs of the facility, both clinical and business office. In new construction or a remodel, you should do everything possible to "future-proof" the facility, and particularly in patient and clinical areas. For example, on opening day you may not plan to put patient monitoring equipment in pre-op or PACU, or provide a ceiling-mount monitor or anesthesia workstation in the OR. But if you add those later, what would have cost a few hundred dollars during construction can be tens of thousands of dollars after the center is up and running. And if you add in the lost revenue of an OR being down for several days, combined with re-working the entire sterile corridor, it can easily represent a six-figure cost.
Careful and thoughtful planning up-front can allow you to add new technologies later without tearing out walls or ceilings or performing other "forklift upgrades." It has the same fundamentals as building the surgery center. If you properly design and build the foundation, the walls, the HVAC system, then you can always add more people, more furniture, more artwork on the walls, etc.
Rule #2: Focus on the core fundamentals of IT (and avoid the "bleeding edge"). There are all kinds of new technology gadgets out there, advertised as "plug and play" (knowledgeable IT people refer to them more accurately: "plug and pray.") But you need to understand a couple of things: (1) most brand new IT devices have bugs or other issues that aren't completely worked out, so the first users are literally almost like beta testers; and (2) most devices you see advertised are for consumers, not for businesses, so the functionality you may see on TV only works for individual devices, not for multiple devices working on a corporate network. And they also show bandwidth and throughput speeds that are unrealistic (You know those ads that have a disclaimer that says, "Shown larger than actual size?" Some IT gadget ads should say, "Shown with an internet connection with unlimited speed.")
To make all these cool user devices work in an office typically requires robust back-end systems and infrastructure, which costs a significant amount of money to properly engineer and configure. For example, all those Starbucks WiFi hot spots work because they are backed up by a robust broadband network and all kinds of devices hidden in the ceilings and walls, all of which had to be designed with proper power, ventilation and network access. If you focus on making sure you have the proper core infrastructure of server architecture, networking, data security, backup systems and proper power and cooling, you can always add new user devices later, without having to re-do your core systems.
Rule #3: Do IT professionally. It sounds counterintuitive, but if you spend too little on IT, it may end up costing you money. Between systems that have a short lifespan to experiencing significant downtime, trying to save money on IT can actually cost you in the long term. In fact, if you don't spend a certain amount to achieve a sufficiently stable and functional platform, you should probably stick with paper records, a clipboard and a big file room (and possibly roller skates).
Between hardware/software and professional services, how do you determine your needs and get the appropriate solutions?
Have you ever shopped for a server? You can see them advertised from $1,500 to $45,000. You probably think instinctively that your ASC probably doesn't need the $45k behemoth, but can you get by with the $1,500 cheapie? You can buy IT hardware from just about anywhere: a big box store, the internet, an appliance store, even from your local MegaMart. The cheap ones may appear to have the same specifications and horsepower as more expensive systems. How do you sort that out?
It's really very simple. Just like you don't buy a camp cot for an exam table, or a card table for your front check-in desk, you don't want to buy cheap, end-of-life IT systems for your ASC. Look at one of the doors in your ASC, and compare it with a door in your house. They may have the same size, and generally have the same functionality, but inside they are fundamentally different. The same thing is true for IT systems. Business-class IT systems have more substantial components inside and are "beefier," therefore they last longer and have less downtime, which means they provide more efficiency.
On the service side, there are many IT "guys" who advertise very low rates and work out of their basement. On the other end of the spectrum are the big national consultancies, where a $500,000 IT project is considered too small. How can you tell the difference, and how do you determine what you need?
In medicine, there are specialties (ortho, OB, cardio, etc.) and certifications/degrees (MD, DO, RN, MA, lab tech) that clearly designate and communicate a person's training and skill set. Unfortunately in IT, the initials and certifications aren't so easy. What's the difference between a DBA and a CNE? If someone can make my e-mail work and fix my superbills, does that mean he can re-do my server room?
Again, it is fairly simple but you must work at not getting intimidated by the jargon, and stick to the basics. Ask your IT vendors about experience that specifically matches your needs. Just like you wouldn't have a home handyman build you a house, you don't want a desktop support guy designing the IT systems for your new ASC. If you have a LAN/WAN issue, the best Java or database analyst in the world can't help you. Don't be intimidated. Just explain your problem and then ask them to describe how they solved your same problem for someone else (or several someones … you don't really want this to be their first rodeo.)
Managing IT costs in an ASC takes the same effort and follows the same process as in all other operational areas: do your homework, become educated enough to separate fact from fiction, get references from similar projects and use the same common sense that have proven valuable in other areas.
Marion K. Jenkins, PhD, FHIMSS, is founder and CEO of QSE Technologies, which provides IT consulting and implementation services for ASCs and other medical facilities nationwide. Learn more about QSE Technologies at www.qsetech.com.